Health Care Utilization in the 6 Months Following SARS-CoV-2 Infection
Authors: Sara Y. Tartof, Deborah E. Malden, In-Lu Amy Liu, Lina S. Sy, Bruno J. Lewin, Joshua T. B. Williams, Simon J. Hambidge, Jonathan D. Alpern, Matthew F. Daley, Jennifer C. Nelson, David McClure, Ousseny Zerbo, Michelle L. Henninger, Candace Fuller, Eric Weintraub, Sharon Saydah, Lei Qian
Journal: JAMA Network Open (2022)

<h3>Importance</h3> After SARS-CoV-2 infection, many patients present with persistent symptoms for at least 6 months, collectively termed<i>post-COVID conditions</i>(PCC). However, the impact of PCC on health care utilization has not been well described. <h3>Objectives</h3> To estimate COVID-19–associated excess health care utilization following acute SARS-CoV-2 infection and describe utilization for select PCCs among patients who had positive SARS-CoV-2 test results (including reverse transcription–polymerase chain reaction and antigen tests) compared with control patients whose results were negative. <h3>Design, Setting, and Participants</h3> This matched retrospective cohort study included patients of all ages from 8 large integrated health care systems across the United States who completed a SARS-CoV-2 diagnostic test during March 1 to November 1, 2020. Patients were matched on age, sex, race and ethnicity, site, and date of SARS-CoV-2 test and were followed-up for 6 months. Data were analyzed from March 18, 2021, to June 8, 2022. <h3>Exposure</h3> SARS-CoV-2 infection. <h3>Main Outcomes and Measures</h3> Ratios of rate ratios (RRRs) for COVID-19-associated health care utilization were calculated with a difference-in-difference analysis using Poisson regression models. RRRs were estimated overall, by health care setting, by select population characteristics, and by 44 PCCs. COVID-19–associated excess health care utilization was estimated by health care setting. <h3>Results</h3> The final matched cohort included 127 859 patients with test results positive for SARS-CoV-2 and 127 859 patients with test results negative for SARS-CoV-2. The mean (SD) age of the study population was 41.2 (18.6) years, 68 696 patients in each group (53.7%) were female, and each group included 66 211 Hispanic patients (51.8%), 9122 non-Hispanic Asian patients (7.1%), 7983 non-Hispanic Black patients (6.2%), and 34 326 non-Hispanic White patients (26.9%). Overall, SARS-CoV-2 infection was associated with a 4% increase in health care utilization over 6 months (RRR, 1.04 [95% CI, 1.03-1.05]), predominantly for virtual encounters (RRR, 1.14 [95% CI, 1.12-1.16]), followed by emergency department visits (RRR, 1.08 [95% CI, 1.04-1.12]). COVID-19–associated utilization for 18 PCCs remained elevated 6 months from the acute stage of infection, with the largest increase in COVID-19–associated utilization observed for infectious disease sequelae (RRR, 86.00 [95% CI, 5.07-1458.33]), COVID-19 (RRR, 19.47 [95% CI, 10.47-36.22]), alopecia (RRR, 2.52 [95% CI, 2.17-2.92]), bronchitis (RRR, 1.85 [95% CI, 1.62-2.12]), pulmonary embolism or deep vein thrombosis (RRR, 1.74 [95% CI, 1.36-2.23]), and dyspnea (RRR, 1.73 [95% CI, 1.61-1.86]). In total, COVID-19-associated excess health care utilization amounted to an estimated 27 217 additional medical encounters over 6 months (212.9 [95% CI, 146.5-278.4] visits per 1000 patients). <h3>Conclusions and Relevance</h3> This cohort study documented an excess health care burden of PCC in the 6 months after the acute stage of infection. As health care systems evolve during a highly dynamic and ongoing global pandemic, these data provide valuable evidence to inform long-term strategic resource allocation for patients previously infected with SARS-CoV-2.